Treat High Blood Pressure Less Aggressively in Older Adults

The Eight Joint National Committee has released new guidelines for managing high blood pressure, specifically addressing three areas of concern—when to start blood pressure medication, the best medications to begin treatment, and target goals to attain while on therapy.

The take-away messages:

• Patients 60-years-old or elder with hypertension should aim for a blood pressure level of less than 150/90 mm Hg. Furthermore, people between the ages of 30 and 59, as well as adults with diabetes or kidney disease, should aim for a diastolic goal of less than 90 mm Hg and a systolic goal less than 140/90 mm Hg.

• Threshold blood pressure levels to begin treatment should be 150/90 mm Hg for patients aged 60 or older. Note: High blood pressure is still defined at 140/90 mm Hg. Treatment for older patients (60+) is recommended to begin at a higher threshold.

• A healthy diet, weight control, and regular exercise have the potential to improve blood pressure control and reduce medication dependency. A government-appointed panel updated the guidelines, but the government has not offered an endorsement.

Updated guidelines from the American Heart Association and American College of Cardiology are expected in late 2014.

The heart association is concerned that the new recommendations are based on studies that did not last long enough to track dangers of undertreated blood pressure in older patients. The full set of guidelines is published in the December issue of the JAMA.

Reference:

1. James P, Oparil S, Carter B, et al. 2014 Evidence-based guideline for the management of high blood pressure in adults. Report from the panel members appointed to the Eight Joint National Committee (JNC 8). JAMA. 2013 Dec 18. doi:10.1001/jama.2013.284427